Getting Prior Authorization
Your doctor will need an approval from your insurance company before insurance will cover the sacroiliac joint fusion cost. This approval is called “prior authorization.” Talk to your doctor or insurance carrier for more specific information.
Medtronic Support
Medtronic is focused on improving patient access to Medtronic therapies and technologies. Medtronic provides a service, Therapy Access Solutions (TAS), to help you navigate the authorization and appeal process.
The TAS program offers information, training, and support for our customers. Contact the TAS staff toll-free at 866-446-3873 for assistance with prior authorizations, denial management, and appeals.
Getting Approval from Your Insurance Company
Medical insurance can help you manage the SI joint fusion cost. However, sometimes your insurance provider might not agree with your doctor's recommendation. Knowing how to communicate effectively with your insurance company can be the first step toward a successful claim resolution and coverage for the SI joint fusion cost.
Your health insurance policy is a contractual arrangement between you and your insurance company. Your policy lists the services that are covered and those that are not. Both you and your insurance company are bound by the terms of the agreement. Refer to your specific health insurance policy to understand your coverage for sacroiliac joint fusion cost.
Ideally you, your doctor, and your insurance company cooperate to help you get the treatment you need:
- Your doctor recommends a treatment or surgery.
- You or your doctor files the paperwork to get the treatment authorized by your insurance company before you have treatment.
- An insurance company representative notifies you or your doctor about the extent to which the treatment will be covered.
- You undergo the treatment or procedure and your insurance company pays for it, less any co-pay or deductible.
Prior Authorization Denials
Sometimes, your insurance company may not be willing to provide coverage for a treatment or surgery. Possible reasons include:
- The treatment or surgery is specifically not covered under the terms of your policy.
- The treatment may be covered, but with restrictions. For example, you may be required to go to a doctor within your insurance provider's physician network. Or, the treatment may be covered, but only for a specific diagnosis.
- Your doctor recommended treatment that involves new technology that your insurance company considers experimental or investigational.
- Your insurance company has determined the treatment is not medically necessary.
Appealing Your Insurance Company’s Decision
Insurance companies are required to provide you with information on how to have the company’s decision reviewed and reconsidered.
If you provide the right information according to the insurance company's policies and procedures, the company may overturn a prior authorization denial.
Your appeal is more likely to be successful if you clearly state your reasons and provide supporting documentation. For example, you might include
- A Letter of Appeal (from you or your doctor)
- A Letter of Medical Necessity (from your doctor)
In instances where new technology is an issue, you may want to include copies of peer-reviewed journals and clinical outcomes data regarding the treatment.